Functional, structural, and emotional correlates of impaired insight in cocaine addiction.
Functional, structural, and emotional correlates of impaired insight in cocaine addiction.
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DOI：
10.1001/jamapsychiatry.2013.2833
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发表时间：
2014-01
期刊：
影响因子：
25.8
通讯作者：
Goldstein, Rita Z.
中科院分区：
文献类型：
--
作者：
Moeller, Scott J.;Konova, Anna B.;Parvaz, Muhammad A.;Tomasi, Dardo;Lane, Richard D.;Fort, Carolyn;Goldstein, Rita Z.
患有可卡因使用障碍（CUD）的个体难以监测正在进行的行为，这可能源于有助于洞察力和自我意识的大脑区域的功能障碍[例如，前扣带皮层（ACC）]。为了检验以下假设：自知力受损的CUD（iCUD）将显示异常（A）错误处理期间的ACC活动，在经典抑制控制任务期间使用功能性磁共振成像进行评估;（B）使用基于体素的形态测量法评估的ACC灰质完整性;以及（C）使用情绪意识水平量表（LEAS）评估的对自身情绪体验的意识。使用先前验证的概率选择任务，我们根据洞察力对33个CUD进行分组[iCUD：N=15;未受损的洞察力CUD：N=18];我们还研究了20个健康对照，所有人都有未受损的洞察力。多模态成像设计。布鲁克海文国家实验室临床研究中心。33名CUD患者和20名健康对照。功能性磁共振成像、基于体素的形态测量、LEAS和药物使用变量。与其他两个研究组相比，iCUD显示出较低的（A）错误诱导的吻侧ACC（rACC）活性，与更频繁的可卡因使用相关;（B）rACC内的灰质;（C）LEAS评分。这些结果表明，rACC功能和结构异常，减少情绪意识，在一个亚群的CUD的特点是受损的洞察力。由于rACC参与评估错误和其他类型的自我参照处理的情感/动机意义，因此该区域的功能和结构异常可能导致对行为结果的关注减少（通常归因于最小化和否认），而行为结果可能最终导致药物使用增加。针对该CUD亚组的治疗可以集中于增强错误的显著性（例如，失效）。
Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions subserving insight and self-awareness [e.g., anterior cingulate cortex (ACC)]. To test the hypothesis that CUD with impaired insight (iCUD) would show abnormal (A) ACC activity during error processing, assessed with functional magnetic resonance imaging during a classic inhibitory control task; (B) ACC gray matter integrity assessed with voxel-based morphometry; and (C) awareness of one’s own emotional experiences, assessed with the Levels of Emotional Awareness Scale (LEAS). Using a previously validated probabilistic choice task, we grouped 33 CUD according to insight [iCUD: N=15; unimpaired insight CUD: N=18]; we also studied 20 healthy controls, all with unimpaired insight. Multimodal imaging design. Clinical Research Center at Brookhaven National Laboratory. Thirty-three CUD and 20 healthy controls. Functional magnetic resonance imaging, voxel-based morphometry, LEAS, and drug use variables. Compared with the other two study groups, iCUD showed lower (A) error-induced rostral ACC (rACC) activity as associated with more frequent cocaine use; (B) gray matter within the rACC; and (C) LEAS scores. These results point to rACC functional and structural abnormalities, and diminished emotional awareness, in a subpopulation of CUD characterized by impaired insight. Because the rACC has been implicated in appraising the affective/motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments targeting this CUD subgroup could focus on enhancing the salience of errors (e.g., lapses).
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